Li is a Chinese gentleman in his 50s whose first language is Mandarin, but has limited use of English.
Li sustained a brain injury as a result of carbon monoxide poisoning, which was believed to have been caused by a faulty boiler in his accommodation. An additional complicating factor was that it was hypothesised he was suffering from PTSD as a result of this incident.
Li was referred to St Peter’s Hospital on an emergency basis following the closure of his service by CQC. St Peter’s staff were able to respond to the referral request within a few hours, assessing Li in-situ at his then placement.
Observation of Li confirmed that he showed little interaction giving limited eye contact and that he spent of most of his time pacing in an endless pattern. He presented with flat affect and was not observed to respond verbally to any questions or remarks made to him and his mood appeared to be depressed.
His staff team confirmed that Li’s medication had been prescribed by a local GP and had not had a consultant neuropsychiatric review for over 2 years.
Li was transferred to St Peter’s the morning after his assessment. On admission, he presented with Akathisia; he was constantly restless, pacing in circles and unable to sit down to engage in activities, communicate with staff or even to eat.
What did Li and his Commissioners want to achieve?
- A complete review of his medication
- Reduce his restlessness and agitation
- Improve his communication
- Encourage greater social engagement
- Improve his dietary intake
What did we do to achieve these goals?
Li’s Akathisia increased his risk of falls requiring careful observation and a detailed care plan. A medication review was immediately carried out as Li had been prescribed a regime of toxic antipsychotics. He was also over-sedated which reduced his ability and motivation to engage as well as adding to his risk of falls.
Since Li has been at St Peter’s he has been gradually taken off Amitriptyline and a small dose of Diazepam introduced which has helped to reduce his restlessness and agitation.
It was reported by staff at his previous placement that Li was totally non-verbal and also that he would only eat Chinese food. From his admission staff with knowledge of Mandarin were integrated within his care team.
Chinese food and chopsticks were ordered for him and this, together with a reduction in his restlessness, has enabled him to sit at a table and enjoy his meals. He has even developed a great liking for traditional British puddings. Nonetheless, Li continues to be provided with a specialist diet which meets his ethnic and cultural needs.
Within our Reminiscence Suite Li has been able to watch Chinese videos/films and TV programs which have been bought for him.
Li’s room has been decorated to reflect his heritage, with Chinese lanterns hanging from the ceiling and pictures of typical Chinese art, fans and objects on display.
Liang has leave to the community and is shopping for celebrations for the Chinese New Year at the end of January to celebrate the Year of the Rat.
Li’s speech is dysarthric and Speech and Language Therapists have worked closely with staff and Li to augment his communication. A basic vocabulary has been established for staff to facilitate communication. He is also being assessed to determine whether technological aids will assist him further in his communication.
Occupational Therapists have carried out a sensory assessment and developed a range of sensory items to meet his sensory needs and provide him with the necessary stimulation. He now enjoys cognitive stimulation sessions, reminiscence therapy, singing for the brain, cooking and other activities on a daily basis.
Li also has a Positive Behavioural Support plan in place. Developed by the Psychology team, the plan provides clear guidance for all staff when supporting him.
What were the outcomes for Li?
Li’s revised medication programme has reduced his restlessness and agitation.
The integration of familiar cultural stimuli has helped alleviate his frustration and confusion, and he is often seen smiling and interacting with the staff.
Although Li has difficulty communicating verbally he can now respond and engage in limited conversations. It is hoped that this improvement in his ability to engage will re-establish links with his family.
He now eats and drinks more which has had a positive impact on his overall health and wellbeing.
Li now regularly goes out on community leave which he had not been able to do prior to moving to St Peter’s.
Li’s Care Coordinator has stated that ‘I don’t want Li to ever leave St Peter’s Hospital’.